Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
Int J Clin Oncol. 2021 Oct;26(10):1938-1946. doi: 10.1007/s10147-021-01983-z. Epub 2021 Jul 7.
With population aging, the number of frail patients with pancreatic cancer has increased. The Clinical Frailty Scale (CFS) is a simple and validated tool to assess frailty, and higher scores predict worse clinical outcomes after cardiovascular surgery. In this retrospective study, we aimed to examine the association of preoperative frailty with prognosis after resection for pancreatic cancer.
We retrospectively analyzed data from 142 consecutive patients undergoing resection for pancreatic cancer between April 2010 and December 2018. We used the CFS: 1 (very fit) to 9 (terminally ill) to assess frailty and examined associations of the CFS scores with recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). Multivariable Cox proportional hazards models were used to calculate hazard ratios (HRs), controlling for potential confounders.
Of the 142 patients, 113 (80%) had CFS scores of ≤ 3, 13 (9.2%) scores of 4, and 16 (11%) scores of ≥ 5. Scores of ≥ 5 on the CFS were associated with worse CSS (univariable HR: 2.62, 95% confidence interval [CI]: 1.19-5.18, P = 0.019; multivariable HR: 2.49, 95% CI 1.05-5.34, P = 0.039) and OS (univariable HR: 2.42, 95% CI 1.19-4.46, P = 0.016; multivariable HR: 2.25, 95% CI 1.05-4.43, P = 0.038). The association between CFS scores and RFS was not significant in multivariable analysis (univariable HR: 2.11, 95% CI 1.08-3.79, P = 0.030; multivariable HR: 1.47, 95% CI 0.71-2.83, P = 0.29).
Higher scores on the CFS are associated with worse CSS and OS after resection for pancreatic cancer. Preoperative measurement of frailty may improve risk assessment among patients with pancreatic cancer.
随着人口老龄化，患有胰腺癌的虚弱患者数量有所增加。临床虚弱量表（CFS）是一种简单且经过验证的评估虚弱的工具，较高的评分预示着心血管手术后临床结局较差。在这项回顾性研究中，我们旨在研究术前虚弱与胰腺癌切除术后预后的关系。
我们回顾性分析了 2010 年 4 月至 2018 年 12 月期间连续接受胰腺癌切除术的 142 例患者的数据。我们使用 CFS：1（非常健康）至 9（生命垂危）来评估虚弱程度，并检查 CFS 评分与无复发生存率（RFS）、癌症特异性生存率（CSS）和总生存率（OS）之间的关系。多变量 Cox 比例风险模型用于计算风险比（HR），并控制潜在混杂因素。
在 142 例患者中，113 例（80%）的 CFS 评分≤3，13 例（9.2%）评分 4，16 例（11%）评分≥5。CFS 评分≥5 与较差的 CSS（单变量 HR：2.62，95%置信区间[CI]：1.19-5.18，P=0.019；多变量 HR：2.49，95%CI 1.05-5.34，P=0.039）和 OS（单变量 HR：2.42，95%CI 1.19-4.46，P=0.016；多变量 HR：2.25，95%CI 1.05-4.43，P=0.038）相关。多变量分析中 CFS 评分与 RFS 之间的相关性不显著（单变量 HR：2.11，95%CI 1.08-3.79，P=0.030；多变量 HR：1.47，95%CI 0.71-2.83，P=0.29）。
CFS 评分较高与胰腺癌切除术后 CSS 和 OS 较差相关。术前虚弱评估可能会改善胰腺癌患者的风险评估。
